Separate health care bills were finally approved in both the House and Senate during Christmas week. The two pieces of legislation will need to be reconciled in a joint House-Senate conference, so nothing’s final, but the end result will almost certainly bring the security of health insurance to tens of millions more Americans.

One thing is already clear: the reforms won’t be perfect. They’ll be incredibly expensive, and though both bills are said to be deficit-neutral, efforts to clamp down on rising costs come mainly in the form of pilot programs, dozens of them. To secure adequate votes for the initial bills, our elected officials engaged in unsavory horse-trading, most notably over public funding for abortion, and you can bet on more of the same before it’s all said and done. But we ought not let perfection be the enemy of the possible. Denying millions of Americans health insurance is not an acceptable way to control costs, and as our present experience suggests, it doesn’t work.

These bills are a good start, but the need for reform doesn’t end here. The health care experience even for those who are insured can be very challenging, and we’ll discuss that further in the months to come.

audrey young

I'm a general internist from Seattle. My first book was What Patients Taught Me. The latest book is House of Hope and Fear, published in August 2009, and now out in paperback. For more about both books and about physician writers, please visit my website.